Hiki Naoki, Fukunaga Tetsu, Yamaguchi Toshiharu, Ogura Toshihiro, Miyata Satoshi, Tokunaga Masanori, Ohyama Shigekazu, Sano Takeshi
Gastroenterological Center, Department Gastroenterological Surgery, Cancer Institute ARIAKE Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake Koto-ku, Tokyo, 135-8550, Japan.
J Gastrointest Surg. 2009 Apr;13(4):626-33. doi: 10.1007/s11605-008-0768-4. Epub 2008 Dec 17.
Fat volume and large abdominal shape are known to disrupt the procedures of lymph node retrieval used in gastric cancer surgery. The present study examined the effect of increasing fat content on surgical outcomes, including estimated blood loss and the number of lymph nodes retrieved during gastrectomy.
Of 154 patients, 50 underwent the conventional open procedure (OPEN) and 104 underwent laparoscopy-assisted distal gastrectomy (LADG). The BMI-related factors of total fat, subcutaneous fat, and visceral fat area, as well as the peritoneum-celiac axis distance were calculated by computed tomography. Regression analysis was used to determine the effects of BMI-related factors that obstruct the surgical procedures on the specific outcomes of estimated blood loss and the number of lymph nodes retrieved.
In the OPEN, but not in the LADG, increases in all BMI-related factors were related to increases in estimated blood loss. The increases in BMI, subcutaneous fat, and the peritoneum-celiac axis distances were related to decreased numbers of retrieved lymph nodes only in the OPEN. Only the factor of visceral fat at the celiac level was modestly associated with a decreased number of dissected lymph node in both groups.
The present study demonstrated that increased fat content and large body shape have little effect on the number of lymph nodes retrieved and blood loss in LADG. However, for patients undergoing conventional open distal gastrectomy, increased fat content and large body shape do impact on the amount of blood lost and the number of lymph nodes retrieved.
已知脂肪量和大腹体型会干扰胃癌手术中淋巴结清扫的操作。本研究探讨了脂肪含量增加对手术结果的影响，包括估计失血量和胃切除术中清扫的淋巴结数量。
154例患者中，50例行传统开放手术（OPEN），104例行腹腔镜辅助远端胃切除术（LADG）。通过计算机断层扫描计算总脂肪、皮下脂肪和内脏脂肪面积等与BMI相关的因素，以及腹膜-腹腔干轴距离。采用回归分析来确定阻碍手术操作的与BMI相关因素对估计失血量和清扫淋巴结数量等特定结果的影响。
在OPEN组中，而非LADG组中，所有与BMI相关的因素增加均与估计失血量增加有关。仅在OPEN组中，BMI、皮下脂肪和腹膜-腹腔干轴距离的增加与清扫淋巴结数量减少有关。仅腹腔干水平的内脏脂肪因素在两组中均与清扫淋巴结数量减少有适度关联。
本研究表明，脂肪含量增加和体型较大对LADG术中清扫的淋巴结数量和失血量影响较小。然而，对于接受传统开放远端胃切除术的患者，脂肪含量增加和体型较大确实会影响失血量和清扫的淋巴结数量。
